The loneliest place on earth . . .

. . . is inside an MRI machine. For those that haven’t had the pleasure, think of being inserted into a torpedo tube. The initial solitude is quickly obliterated by a deafening “battle stations” siren, which in turn is interrupted by incessant thumping and jackhammering. It’s all for a good cause, of course. The machine produces a strong magnetic field that forces the protons in the nuclei of the hydrogen atoms in your body to line up, while a pulsating secondary field of different orientation knocks some of those protons out of alignment. When those protons drift back into alignment with the primary field, a measurable radio signal is produced. It turns out that the protons that comprise the different tissues of the body realign at different speeds, producing variable radiofrequencies that can be measured, identified, and imaged. Try getting that kind of service in Chinatown . . .

Because the MRI had been requested by my primary care physician, the total cost is covered by my health insurance. Zero copay. Nevertheless, I inquired at the front desk as to what an MRI costs these days. One phone call later I had my answer: $3,358.00 with contrast medium, $1,572.00 without contrast. I was on red alert that they might be inclined to want to inject me with contrast.

I was escorted into the MRI room by the technician that would load me into the torpedo tube and push the launch button. I asked whether she could burn a CD with the images for me to take with me after we were done. She indicated that I could make that request at the front desk and that a CD would be available to me 24 hours later. Fair enough.

Paul: “I know that you can’t say anything to me about the test afterwards but would it be okay if I looked at an image on my way out?”
Technician: “Sorry but that’s not allowed until after a doctor has reviewed the images.”

I must have looked confused.

Technician: “Blame the State of California. It’s because of HIPAA regulations. It’s to protect patient confidentiality.”
Paul: “But I AM the patient . . .”
Technician: “I don’t make the rules.”

This was going to be a tough nut to crack.

Technician: “We may inject you with a contrast medium at some point.”
Paul: “That hasn’t been done before on any of my prior MRIs.”
Technician: “It’s up to the radiologist. He will review the results after the first couple of series and decide whether he wants contrast.”
Paul: “You know, I kinda try to limit the amount of stuff that gets injected into my veins during medical procedures. If he decides he wants contrast, I’d like to speak with him so that I can be sure that there’s a compelling reason.”
Technician: “Okay. The contrast is sometimes helpful to differentiate scar tissue and things like that.”
Paul: “I haven’t had any surgery in the area that we are looking.”
Technician: “You can always refuse the contrast. It’s your body – we can’t make you do anything you don’t want to do.”
Paul: “Thank you. I’d be inclined to refuse contrast unless there’s a compelling reason.”

As you lie there in that tube, subjected to the chaotic cacophony, you have no idea what dragons may be being conjured up on the monitor. You only know that if they are there, you will be asked to slay them soon. Only one human on the planet has an inkling of your future, a total stranger in a room only 15 feet away. But she is sworn to secrecy regarding what the crystal ball reveals.

After what seemed to be about 20 minutes of contemplation inside a torpedo tube on a submarine undergoing a major overhaul, the roaring stopped. I was extracted from the tube.

Technician: “We’re all done.”
Paul: “Did the radiologist decide that he didn’t need contrast?”
Technician: “I didn’t even call him to look at the images because you said you’d refuse.”

This was my chance to try to pry some information out of her. I chose my next words very carefully:

Paul: “What I said was that there would have to be a compelling reason. For instance, if he couldn’t be sure whether he was looking at a cyst or a sarcoma, and that the contrast would facilitate a definitive diagnosis, then I’d likely agree to contrast.”

This statement was designed to illuminate whether she had seen something or not. If she had, and if she is not qualified to diagnose (which I suspect she is not), then she would have to call the radiologist. Here was her response:

Technician: “You’re all done” she said with a strange mix of forced cheer and exasperation.

So either there was nothing there, or if there was it was clearly either a cyst or a sarcoma, or if not clearly one or the other then it was clear to her that contrast would not help. In other words, I do not know anything more than I did when I walked in. As was their intention. But by tomorrow afternoon a doctor will have reviewed the images and I will then have the "right" to look at them myself (I will include a representative image in tomorrow’s post). And on Friday morning I will meet with my primary care physician to discuss the MRI and next steps.